Focus On: Co-prescribing Probiotics and Prebiotics with PPIs in India - Five Commandments - Video

Published in the latest December issue of JAPI, the survey included 1007 health care professionals (HCPs) from across India. Based on consensus results, panelists recommended five commandments.

1. Perform a thorough clinical evaluation before prescribing PPIs (level 1)

2. Prescribe PPIs for a short-term duration (≤8 weeks). If long-term therapy is prescribed, reassess the need for continuation periodically and attempt to taper or discontinue if possible (level 2)

3. Educate patients about potential side effects associated with long-term PPI use, especially abnormal bowel habits, bloating, micronutrient deficiencies, flatulence, and abdominal pain (level 2)

4. Co-prescribe pre- and probiotics with PPIs when managing patients with Antibiotic-associated diarrhoea, and those experiencing abnormal bowel habits, bloating (level 1), micronutrient deficiencies, flatulence, and abdominal pain (level 2)

5. Consider co-prescribing pre- and probiotics for >3 months to achieve favorable outcomes and improve overall quality of life (level 1), while monitoring and assessing their effectiveness regularly.

PPI: proton-pump inhibitor

Level 1: >50% agreed; level 2: 30-50% HCPs agreed

Also check part 1: https://medicaldialogues.in/news/insights-into-co-prescribing-probiotics-and-prebiotics-with-ppis-in-india-122022

Adapted from:

Kalra S et al. The Scope of Pre- and Probiotics as an Add-on to Proton-pump Inhibitors in Various Clinical Indications. J Assoc Physicians India 2023;https://doi.org/10.59556/ japi.71.0409